Pediatric Mechanical Circulatory Support

Mechanical circulatory support (MCS), including extracorporeal membrane oxygenation (ECMO) and ventricular assist device (VAD) implantation in pediatrics, has become standard therapy for end-stage heart failure that is refractory to medical management. MCS can be used as a bridge to heart transplantation or transplant candidacy, myocardial recovery, or destination therapy. MCS implantation should be considered when the overall potential survival and quality of life benefits of MCS support outweigh the risks of device compared with continued medical management. The threshold for MCS implantation, determination of MCS candidacy, and preimplantation preparation requires a multidisciplinary approach with shared decision-making with the family. Devices can be categorized by anticipated duration of therapy (temporary vs. durable support), implant configuration (e.g., paracorporeal vs. intracorporeal; left, right, single, or biventricular support), and type of flow generation (e.g., pulsatile vs. continuous-flow devices). Pediatric patient VAD outcomes continue to improve in the current era, with actuarial survival of 74% at 6 months postimplant. Adverse events remain common; however, with increased center collaboration and quality improvement initiatives, the incidence of neurologic dysfunction on device has declined in the contemporary era.